Circular Loop Ligation for Securing Endobronchial Valve in the Treatment of Bronchial Stump Fistula

Bronchial stump fistula (BSF), which is located on the bronchial stump following pulmonary resection, represents a distinct subtype of bronchopleural fistula (BPF). Although the endobronchial valve (EBV) has been used to treat BPF, few clinical studies involve BSF occluded by EBV because the abnormal bronchial stump makes EBV implantation challenging. The present research reports novel methods of using a circular loop ligation technique for securing EBV to achieve BSF occlusion and a new classification of BSF that is compatible with these novel methods.

Based on the length of the bronchial stump, small visible BSF (SVBSF, less than 8 mm) is classified into the following types: SVBSF1 (< 3 mm), SVBSF2 (≥ 3 mm but shorter than a normal bronchus), and SVBSF3 (preserves a complete bronchial structure). SVBSF2 is further classified into SVBSF2a (the stump base remains partially intact) and SVBSF2b (complete destruction of the stump base). This retrospective research involved SVBSF2 patients who underwent EBV fixation with circular loop ligation. Detailed medical records were collected and analyzed to evaluate the efficacy of the novel procedure.

A total of 15 patients underwent EBV implantation and fixation. All patients achieved a resolution of air leakage. Postoperative assessment revealed no instances of EBV displacement among VBSF2a patients, with all cases exhibiting significant improvement.

The circular loop ligation methods for securing the EBV enable effective BSF closure in SVBSF2, especially SVBSF2a cases. This technique enables some BSF patients with abnormal structures at bronchial stumps to successfully perform the EBV occlusion.